Propofol Pharmacology

On this episode of the Real Life Pharmacology podcast, I breakdown propofol pharmacology. Propofol is a CNS depressant that is used for general anesthesia. I discuss propofol infusion syndrome in this episode and what to look out for clinically. Adding a benzodiazepine or opioid to propofol may have a synergistic effect and the propofol dose may need to be reduced.

Glucagon Pharmacology

On this episode of the RLP podcast, I discuss glucagon pharmacology. It is important to remember with glucagon that patients will still require glucose following administration to improve their blood sugar numbers. Glucagon is typically reserved for moderate to severe episodes of hypoglycemia when patients have altered consciousness. The major adverse effect with glucagon is nausea and vomiting which often may prevent oral intake of glucose for some time after administration.

Dulaglutide Pharmacology

Dulaglutide is a GLP-1 agonist used in the management of diabetes. Dulaglutide has 4 different dosages that can be used to help lower A1C. As the dose goes up, so does the potential for adverse effects however. Like most of the GLP-1 agonists, dulaglutide is only available as an injection. Semaglutide is an exception to this. Nausea is the primary adverse effect of dulaglutide which some patients may get used to over time.

Dapagliflozin Pharmacology

Dapagliflozin is an SGLT-2 Inhibitor that reduces blood sugar by increasing the excretion of sugar through the urine. Genital and urinary infections is a potential risk with the use of SGLT2 Inhibitors like dapagliflozin. Dapagliflozin has received FDA approval for use in heart failure (in patients even without diabetes). Be aware of agents that may enhance the risk for hypoglycemia such an insulin and sulfonylureas.

Omeprazole Pharmacology

Omeprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis. Omeprazole can inhibit CYP2C19 which can cause concentrations of drugs like escitalopram and citalopram to rise. Hypomagnesemia, low B12, osteoporosis, and an increase in C. Diff risk are potential complications with longer term PPI use. PPI's like omeprazole are best given 30-60 minutes before meals. This is something that patients often forget.

Conjugated Estrogens Pharmacology

Conjugated estrogens (Premarin) are most often used in the management of menopausal symptoms. Estrogen therapy can increase the risk for breast cancer and the risk should be assessed before beginning therapy. Blood clots are a potential consequence from the use of Premarin. Premarin can oppose the benefit of anticoagulation. Conjugated estrogens are broken down by CYP3A4. Inhibitors may increase concentrations while inducers may reduce concentrations.

Paroxetine Pharmacology

Paroxetine (Paxil) is an SSRI that can be used in the management of depression. I discuss more on paroxetine pharmacology in this episode. Because paroxetine has some modest anticholinergic effects, it does show up on the Beers list as a potentially inappropriate medication. By inhibiting CYP2D6, paroxetine can have numerous drug interactions. Drugs like atomoxetine, aripiprazole, and metoclopramide can all have their concentrations increased. Tamoxifen is activated by CYP2D6 and paroxetine can ultimately reduce the effectiveness of the medication.

Olanzapine Pharmacology

Olanzapine is a 2nd generation antipsychotic that blocks dopamine-2 receptors. Olanzapine Relprevv (long acting injectable) needs to be closely monitored after the injection is given due to risks of sedation and delirium. Sedation is a common occurance with the use of olanzapine. It is one of the more sedating second generation antipsychotics. Weight gain, hyperlipidemia, and hyperglycemia are all potential adverse effects with olanzapine.

Tizanidine Pharmacology

Tizanidine is primarily broken down by CYP1A2. Ciprofloxacin can inhibit CYP1A2 and cause higher tizanidine concentrations. Tizanidine has a similar classification as clonidine. Pay attention to adverse effects like hypotension and bradycardia. When patients taking routine tizanidine stop taking it, there is potential for a discontinuation syndrome that may lead to rebound hypertension. Dry mouth and CNS depression are common adverse effects of tizanidine.

Valacyclovir Pharmacology

Valacyclovir can be used for various viral infections such as herpes virus and varicella. The primary clinical advantage of valacyclovir compared to acyclovir is that it is dosed less frequently. Valacyclovir may have some mild CYP1A2 inhibitory effect. I discuss the clinical relevance of this on this episode. GI upset can occur so I usually recommend to give it with food even though it may be given with or without food.